B-2016-3094 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-3094
19479 STEVENS CREEK BLVD CUPERTINO,CA 95014(316 20 112) SIGN OF LIGHT
ROSEVILLE,CA 95678
OWNER'S NAME: MAIN STREET CUPERTINO DATE ISSUED:11/10/2016
OWNER'S PHONE:408-777-3081 PHONE NO:(916)787-9445
► I ..Y t. SC I A. t,t, I k, BUILDING PERMIT INFO:
License Class C-10 Lie.#906191
Contractor SIGN OF LIGHT Date 11/30/2017 X BLDG _ELECT _PLUMB
—MECH_RESIDENTIAL X COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing
with Section 7000)of Division 3 of the Business&Professions Code and that my ,
license is in full force and effect. JOB DESCRIPTION:
INSTALL 2 ILLUMINATED WALL SIGNS-AT&T
I hereby affirm under penalty of perjury one of the following two declarations: REV#1-ADD AT&T NEXT TO LOGO-ISSUED 11/29/2016
1. I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
-performance of the work for which this permit is issued.
V(2,(2-1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq..Ft Floor Area: Valuation:$4080.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
information is correct.I agree to comply with all city and county ordinances APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 316 20 112 A(Tenant Improvements)
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We)agree to save indemnify and keep harmless the
City of Cupertino against liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulation er the Cupertino Municipal Code,Section .18. 180 DAYS FROM LAST CALLED INSPECTION.
Sign ture 1 ~Ly( ,- Date 11/29/2016 Issued by:AbbyAyende
Date:11/10/2016
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code), Date:11/29/2016
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. I have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534.I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
s. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous
material.Additionally,should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safe od , ons 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall . .---'
be deemed revoked. pvirner r or authorize age '-?'--a-
APPLICANT CERTIFICATION C Date:11/29/2016
CONSTRUON LENDING AGENCY
I certify that I have read this application and state that the above information is I herebyaffirm that there is a construction lendingagency for the performance
correct.I agree to comply with all city and county ordinances and state laws^ g y
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit. Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
Licensed
Signature Date 11/29/2016 Professional
A
eki 4 i
r 1 SIGN PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION '
S
851,,9'fi, 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•buildinqacupertino.orql'''))
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CONTRACTOR NAMELICENSE NUMBER LICENSE TYPE BUS.LIC#
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COMPANY NAME3
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STREET ADDRESS CITY,STATE,Z
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ARCHTTECT/ENGINEER NAME LICENSE NUMBER 906 p 51/ BUS.LIC P
COMPANY NAME E-MAIL °(tea C FAX
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DESCRIPTION OF WORK -�'
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USE OF D,,$FD or Duplex 0 Multi-Family ILLUMINATED SIGN TYPE NO.OF SIGN AREA VALUATION
STRUCTURE: Commercial (Y/N) (CODE) SIGNS (SQ FL) (5)
SIGN TYPE CODES: ` L. I I f Pii -3,9150 f 9150
B - BANNER SIGN M - MONUMENT(GROUND)SIGN
BL - BLADE SIGN P -PROJECTING SIGN
D - DEVELOPMENT ID SIGN SP - SPECIAL EVENT BANNER
DI - DIRECTIONAL SIGN T TEMPORARY
E - ELECTRONIC W WALL SIGN
READERBOARD WI - WINDOW SIGN g
RECEIVED BY:C�.{i O g uttaL TOTAL VALU TION:
wner or authorized agent to a ton the property owner's behalf. I have read this
By my signature below,I certify to each of the following: I am the property o
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
.
Signature of Applicant/Agent: (t.('---F-----'1.------ Date:_Pi f>
ONLY
TJSE _--
SUPPLEMENTAL INFORMATION REQUIRED OFFICES . __ .. _ ._ _.
PLAN CHECK TYPE ROUTING SLIP
Site Plan
Elevations ���i
D OVER-THE-COUNTERBUILDINGPLAN REVIEW �YV1(, (
Sign Details-including UL listing(s)applicable
0 mumESSPLANNING PIAN REVIEW CGt it VIC
Structural Calculations(if applicable)
STANDARD 0 OTHER:.
Copy of Planning Approval Letter or Meeting with Planning prior to 0 LARGE
submittal of Building Permit application. 0 MAJOR
SignApp 2011.doc revised 03/31/11
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-3094.
19479 STEVENS CREEK BLVD CUPERTINO,CA 95014(316 20 112) SIGN OF LIGHT
ROSEVILLE,CA 95678
OWNER'S NAME: MAIN STREET CUPERTINO DATE ISSUED:11/10/2016
OWNER'S PHONE:408-777-3081 PHoIVE NO:(916)787-9445
LICENSED ONT ACTOR'S DFCLA ATIOA BUILDING PERMIT INFO:
License Class C-10 Lie.#906191
Contractor SIGN OF LIGHT Date 11/30/2017 X BLDG —ELECT —PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing —MECH—RESIDENTIAL X COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
I hereby affirm under penalty of perjury one of the following two declarations: INSTALL 2 ILLUMINATED WALL SIGNS-AT&T
i, I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
el
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by
CSection 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$4080.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
information is correct.I agree to comply with all city and county ordinances APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 316 20 112 A(Tenant Improvements)
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We)agree to save indemnify and keep harmless the
City of Cupertino against liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue againstsaidCity in consequenceandthe comply
hg o this pint 'WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Cod- eetion 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
nature.
9 Date 11/10/2016 Issued by:AbbyAyende
Date: 11/10/2016
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:11/10/2016
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. I have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the material.Additionally,should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked, > --�
Oer or authorized agen — �
APPLICANT CERTIFICATION ,-Date: 11/10/2016 •
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said.City in Lender's Address
consequence of the granting of this permit. Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
Licensed
Signature Date 11/10/2016 Professional
- "6-1010—ebetill
SIGN PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
,s-cipt`- 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333-building( cupertino.orq
q
PROJECT ADDRESS /O s I -7(3 'Skive";
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OWNER NAME L-fJ `d - b2FI"I.UsPHONE �t 66dd ...MAIL
/91
STREET ADDRESS ' CITY,STATE, IP FAX
CONTACT NAME C."(
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STREET ADDRESS / . fCITY, TE,ZIP FAX
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®OWNER 0 OWNERBULDER 0 OWNER AGENT C�CONTRACTOR
0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPERS /❑� TENANT
CONTRACTOR NAME �`iw �r7�'`� LICENSE NUMBER S LICENSE E BUS.LIC# L{ Ai
frail 1 e1P ea I G' '-"( �d ���®
COMPANY NAME . IA G�i� E\ 'm
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STREET ADDRESS 4 q'7 14 S12, )4. CITYice[.ZW f t 6 4 .q,R2 e 'TWO 7;;7 4ti ..
ARCHITECT/ENGINEERNAME N. LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK
A5 ki,1c Ica a- e ' 21. S `ejric ( 1 , q i
USE OF 0 SFD or Duplex 0 Multi-Family ILLUMINATED SIGN TYPE NO.OF SIGN AREA VALUATION
STRUCTURE: Commercial (Y IN) (��C��ODE) SIGNS (SQ.FT.) , I ($)
SIGN ,VV TYPE CODES: 0 9 "/ o I D
B - BANNER SIGN M - MONUMENT(GROUND)SIGN ` e v./ 1 IT B
BL - BLADE SIGN P - PROJECTING SIGN �!
O - DEVELOPMENT ID SIGN SP - SPECIAL EVENT BANNER ._? _, 'v�® ➢ )
DI - DIRECTIONAL SIGN T - TEMPORARY
E - ELECTRONIC W -WALL SIGN
READERBOARD WI - WINDOW SIGN
RECEIVED BY:0176A TOTAL VALUATION:�
7i ci 0
By my signature below,I certify to each of the following: I am the property owner or authorized agent to ton the property owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to bu'•' construction. I authorize representatives of pertino to enter the above-identified rCoperty for inspection purposes.
Signature of Applicant/Agent: i I �� _ Date:
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
Site Plan PLAN CHECK TYPE p� ROUTING SLIP
Elevations 0 OVER-THE-COUNTER el;WILDINGPLAN REVIEW POLO
Sign Details-including UL listing(s)applicable 0 EXPRESS Ii PLANNING PLAN REVIEW 4)
Structural Calculations(if applicable) 0 STANDARD 0 OTHER:
T Copy of Planning Approval Letter or Meeting with Planning prior to 0 LARGE
submittal of Building Permit application.
0 MAJOR
SignApp 2011.doc revised 03/31/11